Amputation Flashcards
Most amputations are the result of
Peripheral vascular disease PVD especially in older patients with diabetes mellitus
Diagnostic Studies
Hx and physical exam Physical appearance of soft tissues Skin temp Sensory function Presence of peripheral pulses Arteriography Venography - provide circulatory info Plethysmography Transcutaneous ultrasonic Doppler recording
Collaborative care: Medical, Surgical and Rehabilitation
Medical: appropriate management of underlying disease and stabilization of trauma victim
Surgical: residual limb management and immediate or delayed prosthetic fitting
Rehabilitation: coordination of prosthesis-fitting and gait-training activities and or muscle -strengthening and physical theory regimens
The overall goal are that the pt with an amputation will:
- Have adequate relief from the underlying health problem
- Have satisfactory pain control
- Reach max rehab potent ion with use of prosthesis
- Cope with the body image
- Make satisfying lifestyle adjustments
Health Promotion Interventions
Control cause of illness
Teach to examine lower extremities daily
Tell pt of caregiver to report feet or toe changes to health care provider (skin, temp, decreased or absent sensation, tingling, burning pain or lesion)
Instruct about precautions for rec activities and hazardous work potentials
Acute Intervention: pre operative managment
Before surgery they’ll info about why the amputation is being done and proposed prosthesis and mobility training programs.
Know the level of amputation and type of post surgical dressing
Teach about upper body exercise to promote arm strength which is essential for crutch walking and gait training
Discuss post op care or ambulatory expectations for immediate surgery
Talk about phantom limb sensation
Acute Intervention: Postop Managment
Monitor for PTSD, vitals, dressing for hemorrhage.
use sterile technique during dressing changes
Immediate post op: prosthesis applied careful surveillance of the surgical site is required
Have tourniquet available in case of excessive bleeding and notify surgeon immediately
Timing for use of prosthesis depends on
Site of amputation; delayed for above knee or below elbow, older adults, debilitating ppl and those with infection
Depend on: healing and weight barring
What helps to reduce phantom limb sensation and pain in some pt??
Mirror therapy. It tricks the brain into thinking it’s still there.
Why is a compression bandage usually applied after amputation?
To support soft tissues Reduce edema Hasten healing Minimize pain Promote residual limb shrinkage and maturation
It is worn at all times except during physical therapy
When is crutch walking started?
As soon as the pt is physically able
What is taught before discharge?
Residual limb care, ambulatory, prevention of contracture so, recognition of complications, exercise and follow up care.
Daily inspection for skin irritation paying attention to areas prone to pressure
Discontinue prosthesis use if irritation develops and have checked before continuing
Wash residual limb throughly each night with warm water and bacteriostatic soap. Rinse thouraghtly and dry gently. Expose the residual lim to air for 20 min.
Do not use any substances: lotion, alcohol, powers or oils on residual limb unless prescribed.
Change residual limb sock daily. Wash socks in miles soap squeeze and lay flat to dry.
Use prescribed pain managment techniques
Rom to all joints daily. General strengthening exercises including upper body daily.
Don’t elevate residual limb with a pillow
Lay prone with hip in extension for 30 min 3-4x/daily
Gerontological considerations
May not be a candidate for prosthesis due to poor upper body strength. Limits ambulatory ability. Discuss these issues before so that realistic expectations can be set
Define: Amputation
Removal of a body extremity by trauma or surgery
